Rheumatoid Arthritis (RA)
About the disease & condition
Rheumatoid arthritis (RA) is a chronic, systemic autoimmune disorder characterized by persistent inflammatory synovitis, primarily affecting peripheral joints in a symmetric pattern. It leads to progressive joint damage, deformity, and functional disability if untreated, and is often associated with extra-articular manifestations.
Known Symptoms
- Articular features: Symmetric polyarthritis (hands, wrists, knees, feet). Morning stiffness >1 hour, joint swelling, pain, warmth. Progressive deformities (e.g., ulnar deviation, boutonnière/swan-neck deformities).
- Extra-articular manifestations:
Rheumatoid nodules (subcutaneous, often over extensor surfaces). Pulmonary fibrosis, pleuritis, pericarditis.
Vasculitis, scleritis, Sjögren’s syndrome. Cardiovascular disease, osteoporosis. Systemic symptoms: Fatigue, fever, weight loss. - Red flags: Rapid joint destruction, systemic organ involvement.
Known Causes
- Etiology: Genetic predisposition (e.g., HLA-DRB1 shared epitope, PTPN22). Environmental triggers (e.g., smoking, infections, hormonal changes).
- Pathophysiology: Dysregulated immune response with autoantibody production (rheumatoid factor [RF], anti-citrullinated protein antibodies [ACPA]). Synovial inflammation mediated by cytokines (e.g., TNF-α, IL-6, IL-1), leading to pannus formation, cartilage destruction, and bone erosion.
Care
- Prevention: Early diagnosis and aggressive treatment to prevent erosions. Smoking cessation, cardiovascular risk reduction.
- Follow-up: Regular monitoring of disease activity (e.g., DAS28, CDAI). Serial imaging to assess structural damage. Screening for extra-articular features and medication side effects. Vaccinations (avoid live vaccines on immunosuppressants).
Note:
RA requires lifelong management with a treat-to-target approach. Multidisciplinary care (rheumatology, physiotherapy, ophthalmology) is essential. Patient education on self-management and adherence is critical for optimal outcomes.
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